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Prostate Cancer Risk Factors and Outcomes for Black Men

Black men are more likely to get prostate cancer than any other men, with several factors impacting their risk and outcomes.

Prostate cancer is marked by an uncontrolled, malignant growth of cells in the prostate gland. It’s the most common type of cancer found in men in the U.S., aside from skin cancer, and often begins without symptoms. About 1 in 8 men will be diagnosed with prostate cancer in his lifetime.

Black men are at an increased risk for developing prostate cancer over White men and other men of color. Overall, Black men are 1.8 times more likely to be diagnosed with—and 2.2 times more likely to die from prostate cancer than White men.

While there is no clear reason for these differences, several factors can impact cancer risk and outcomes in the Black community. These include age, family history, smoking, limited physical activity, and obesity, says Vincent Laudone, a urologist and Chief of Surgery at Memorial Sloan Kettering Cancer Center. “The higher risk may be related to social and environmental issues involving nutrition, access to health care, and exposure to environmental pollutants,” says Dr. Laudone.

Additionally, prostate cancer in some Black men may have biological characteristics associated with more aggressive disease. “There is evidence suggesting that this is partly related to inherited genetic factors,” says MSKCC medical oncologist Dr. Andrew Laccetti. “There may be differences in tumor biology that cause this cancer in Black men to progress faster or be harder to treat, but we need to investigate this possibility further to learn more.”

Given the higher risk of developing prostate cancer and dying from the disease, clinical outcomes for Black men may be improved by standard prostate-cancer screening. The main prostate cancer screening tests are a digital rectal exam, in which a doctor checks for swelling and lumps and a PSA test, which measures the level of prostate specific antigen (PSA) in the blood.

But Black men may be harmed by racial bias in preventive care, as they are less likely than White men to be offered the option of having a PSA test, and are more likely than White men to be told that the benefits of prostate-cancer screening are uncertain, some research suggests.

Disparities in outcomes also can be affected by differences in how Black men are treated after diagnosis. One study conducted by NYU Langone Health and Perlmutter Cancer Center found that Black men most likely to benefit from advanced prostate cancer therapies are 11% less likely to get them than non-Black men.

One possible reason is that some Black men may have greater fears than others about side effects of therapy, such as the risk of incontinence and erectile dysfunction, according to the study’s researchers. These fears and underlying reasons related to their expectations of treatment should be discussed directly with patients when treatment options are being considered.

Increasing diversity in the medical field would enable Black patients to work with medical professionals who might better understand their cultural and social experiences. This would result in an improved overall patient experience truly meeting the needs of the variety of patients affected by prostate cancer.

Right now, only 2.1% of practicing urologists self-identify as Black or African American and 2.3% of practicing oncologists self-identify as Black or African American.

Despite the disparities, there are many treatment choices for Black men with prostate cancer to explore to help them make the right decision. Some treatments are standard, such as active surveillance, surgery, radiation therapy, hormone therapy, and chemotherapy. Others are being tested in clinical trials, like this one from Lilly for those with late-stage prostate cancer that has spread to other parts of the body and still responds to certain treatments.

Ultimately, reaching a decision on prostate cancer management is a complex, collaborative process between a team of healthcare professionals and the patient. There is a lot to discuss, and treatment options will depend on many factors including the grade and stage of disease, patient preference, and fitness. Sometimes this involves clinical trials, which provide reliable and accurate data that helps inform physicians’ decisions about patient care—at no cost to the patient.

The good news is that the racial divide for prostate cancer outcomes is narrowing, particularly when Black men have the same access to care as White men. Overall, the five-year relative survival rate for Black men diagnosed with prostate cancer at any stage is 96%, which means that if a Black man is diagnosed with prostate cancer today, at any stage, there is a 96% chance he will be alive in five years.

 

This article has been brought to you by Lilly.

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